Same-day discharge after pulmonary wedge resection: a cost-minimization analysis
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Richard C Chaulk1, David Sahai1, Richard Malthaner1
1From the Division of Thoracic Surgery, London Health Sciences Centre, London, Ont. (Chaulk, Malthaner, Fortin, Qiabi, Inculet, Nayak); the Schulich School of Medicine and Dentistry, Western University, London, Ont. (Chaulk, Sahai, Malthaner, Fortin, Qiabi, Inculet, Nayak).
Background:
A recent clinical trial at our centre demonstrated that same-day chest-tube removal and discharge after minimally invasive pulmonary wedge resection (PWR) is safe and feasible. We sought to conduct a cost-minimization analysis comparing same-day discharge with standard postoperative admission.
Methods:
This study is a cost-minimization analysis of a previously published study on same-day chest-tube removal and discharge. We used expected per-case costs (EPCC) as our comparison metric, incorporating mean length of stay, mean cost of 1 inpatient day, costs of emergency-department returns (EDRs), and rates of EDRs.
Results:
The mean length of stay was 2.4 days for the control group and 1.05 days for the intervention group. The mean daily hospital cost was $508.00, and the mean cost of EDRs was $342.00. Rates of EDRs were 0% for the control group and 10% for the intervention group, resulting in an EPCC of $1219.20 for the control group and $567.60 for the intervention group, yielding $651.60 in savings per case. In phase 2, the mean length of stay was 2.4 days for the control group and 0.8 days for the intervention group. Rates of EDRs were 15% for the control group and 8.7% for the intervention group, with an EPCC of $1270.50 for the control group and $440.60 for the intervention group, leading to $829.90 in savings per case.
Conclusion:
Early chest-tube removal and same-day discharge after minimally invasive PWR can significantly reduce costs compared with standard postoperative protocols. Utilization of these strategies could alleviate some of the stress of Canada's currently strained health care systems.